Background Previous randomized controlled trials of revascularization for atherosclerotic renal artery stenosis (ARAS) were not successful. We investigated the effects of percutaneous transluminal angioplasty with stent insertion (PTA/S) on kidney function and blood pressure (BP) control in patients with ARAS. Methods From 2000 to 2017, 47 subjects who underwent PTA/S for ARAS were identified. A high-risk group was defined, composed of patients having one or more of the following clinical presentations: pulmonary edema, refractory hypertension, and rapid deterioration of kidney function. Subjects who met the criteria of ‘kidney function improvement’ or ‘hypertension improvement’ after PTA/S were classified as responders. Results Twenty-one (44.7%) subjects were classified into the high-risk group. Two subjects (8.0%) in the low-risk group (n = 25) and 5 subjects (27.8%) in the high-risk group (n = 18) showed improvement in kidney function after PTA/S ( P = 0.110). In patients with rapid decline of kidney function, estimated glomerular filtration rate improved from 28 (interquartile range [IQR], 10–45) mL/min/1.73 m 2 to 41 (IQR, 16–67) mL/min/1.73 m 2 at 4 months after PTA/S, although the difference was not significant ( P = 0.084). Regarding BP control, 9 (36.0%) and 14 (77.8%) subjects showed improvement after PTA/S in the low- (n = 25) and high-risk (n = 18) groups, respectively ( P = 0.007). In patients with refractory hypertension, the systolic BP dropped from 157 (IQR, 150–164) mmHg to 140 (IQR, 131–148) mmHg at 4 months after PTA/S ( P = 0.005). Twenty-five subjects were defined as responders and comprised a significant proportion of the high-risk group ( P = 0.004). Conclusion PTA/S might improve BP control and kidney function in patients with ARAS presenting with high-risk clinical features. The optimal application of PTA/S should be based on individual assessment of the clinical significance of renal artery stenosis.
Background and Aims Poor health-related quality of life (HRQOL) is associated with increased cardiovascular risk and mortality in patients with kidney disease. Therefore, it is critical to identify and modify clinical contributors of poor HRQOL. This study examined modifiable factors associated with poor HRQOL in patients with diabetic kidney disease (DKD) focusing on depression, anxiety, sleep quality, and physical activity. Method Between April 2017 and March 2018, 141 adults (aged ≥18 years) with DKD were recruited in single tertiary hospital. HRQOL was assessed at baseline with the Short Form 36 of life Health Survey Question (SF-36) questionnaire. Poor HRQOL was defined as a score below the median value at baseline. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. Sleep quality and physical activity were measured using Korean version of the Pittsburgh Sleep Quality Index and International Physical Activity Questionnaire respectively. Results The age was 65 [57-72] years old, and 73% (n=103) of participants were men. Prevalence of anxiety and depression were 8% (n=11) and 17% (n=24) respectively. Forty-eight (34%) subjects corresponded to poor sleepers and 40 (28%) subjects showed low physical activity. SF-36 scores were decreased with advanced CKD stages (stage 3, 79 [71-82]; stage 4, 71 [56-82]; stage 5, 70 [57-82]; p = 0.029 for trend) progressively. Anxiety, depression, and poor sleep quality were negatively correlated with SF-36 scores (p < 0.05). eGFR and physical activity were positively correlated with HRQOL scores (p < 0.05). In multivariable logistic analysis, depression scores were associated poor HRQOL independently of age, sex, comorbidity, eGFR, anemia, sleep quality, anxiety and physical activity (odds ratio per 1-score increment, 1.51; 95% confidence interval, 1.27-1.80, p < 0.001). Conclusion In patients with DKD, depression was a major determinant of poor HRQOL among the modifiable clinical factors such as anxiety and sleep. Active surveillance of depression and psychosocial intervention should be considered to improve the well-being of these patients.
Background and Aims Anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis (GN), the most common form of secondary GN in elderly (>60 years), requires immunosuppressive treatment that may increase risk of opportunistic infections. This study evaluated the prognostic value of clinical factors and histopathologic findings affecting kidney outcome in ANCA-associated GN patients. Method From 2000 to 2018, we identified 106 adults (≥18 years old) who were pathologically confirmed as ANCA-associated GN. The number of normal, crescent, and sclerotic glomeruli was recorded for each biopsy by slide review. The primary outcome was incident end stage kidney disease (ESKD). Results The age was 67 (57-73) years, the estimated glomerular filtration rate (eGFR) was 19 (11-36) mL/min/1.73 m2, and % of normal glomeruli in kidney specimen was 25 (11-47) %. Overall kidney survival was 85% and 76% at 1 and 5 years, respectively. Among clinical variables, lower eGFR (adjusted hazard ratio [aHR], 0.339; 95% confidence interval [CI], 0.180-0.638; p<0.001) was independently associated with increased risk of incident of ESKD. Multivariate Cox proportional hazard model including both clinical and histological variables demonstrated that % of normal glomeruli (aHR, 0.960; 95% CI, 0.935-0.986; p<0.001) was a sole risk factor of incident ESKD, independently of eGFR and other pathological findings. When the % of normal glomeruli was divided by quartiles, the risk of incident ESKD in the lowest quartile was significantly increased compared to the highest quartile (<11%; HR, 5.986; 95% CI, 2.114-16.950 vs. >46%; p<0.001). Conclusion The proportion of unaffected glomeruli was independent predictor of kidney outcome in patients with ANCA-associated GN.
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